A network solution small hospitals can afford
Big-league program at small-town price
Knowledge is power, and to succeed, information is key. But for a small hospital, affording the kinds of systems that provide the best data often is overly expensive and close to impossible. But one small facility has found the critical operational and quality information it needs. Samaritan Healthcare, a 50-bed acute care hospital in Moses Lake, WA, located in a rural area between Seattle and Spokane, knew that with lower Medicare and private reimbursement rates, understanding where money went and how to reduce costs without sacrificing quality of care was vital.
The facility had been using PACE, a product of the Computer Sciences Corporation of El Segundo, CA. But the company dropped the system, and after a year of trying to function on its own, Samaritan executives decided to seek out a new system.
It didn’t help that the region between Spokane and Seattle has experienced some of the fastest growth in the nation, leading Samaritan to start a $20 million construction project to keep pace. Money was tight, says Glen Stambaugh, RRT, director of quality at the hospital, and the typical six-figure intelligence software offerings were completely unaffordable.
"They had wonderful capabilities, but they required high front-end investment in licensing, hardware, and dedicated employees to maintain and operate the infrastructure," he says. He did some research and asked others what products they used. There were two companies — which Stambaugh declines to name — that offered great products but that would have required between $60,000 and $100,000 to start for the capabilities the hospital needed. That was beyond what Samaritan could afford and more than three times what they paid for the defunct but highly capable CSC product. "It would have been out of the question even in a good year," he says.
Lucky for Stambaugh, the old PACE sales representative he used was working for a start-up company called Net-Fast, based in Billerica, MA. "He offered a newly developed solution with capabilities similar to more expensive packages, but at a price we could afford." The price was a relatively low $25,000 per year.
Not that Stambaugh wasn’t concerned about using a product from a new company. "But then again, CSC was established and they quit offering a service, so the risk is inherent in the industry whether a company is new or old," he says.
System allows ease of use, thorough analysis
Net-Fast takes routinely generated transaction data and puts them in a form that is readily available to hospital decision makers. The system is designed to be easy to understand and use but to still allow for thorough analysis of the factors affecting profitability and clinical effectiveness. All of the data and the required software reside on Net-Fast’s secure web site, enabling hospitals to easily access their information without additional infrastructure, software, or hardware costs.
The source data used in the system are extracted by the user hospital and uploaded to Net-Fast on a regular basis. In the case of Samaritan, Stambaugh says, "Our source data is maintained by a consortium of regional hospitals using a shared information system. We alert them when our quarter is completed, and they forward it to Net-Fast." Net-Fast works with them to make it a smooth and simple process.
The Net-Fast reporting module that Samaritan uses, NF Blue, supports a number of clinical and financial applications, says Stambaugh. "We can get information on any procedure, diagnosis, or chargemaster population. We can analyze for utilization, revenue, and outcomes." The data aren’t real time, but they are available within a couple of weeks of transferring them to Net-Fast, which is faster than many products out there. "It’s as close to real-time data without going day to day as we can get," he says. "We could have gone for cheaper options that use state and other public databases, but the data is old and limited by the time you get it."
Stambaugh found NF Blue extremely easy to learn and used it right away to explore revenue-challenged laparoscopic procedure service lines. "We knew changes in Medicare reimbursement had resulted in lost revenue, and it was important to identify waste and potential variances in care which could be addressed to restore viability." Stambaugh used the wide range of data elements available in NF Blue to comb through the procedures and break out charge categories where utilization varied by physician. NF Blue again was applied to rank variances by average value and to compare clinical outcomes.
"We were able to validate that our laparoscopic service line was efficient and safe, with physician practice-related variations in some charge items and missed charges in others," he says. "We shared the variations with the physicians for their consideration, and the missed charges with the Surgery Department to improve the charging process and eliminate, for example, over $3,000 in a single category of lost laparoscopic surgery charges."
Readmissions tracked to one physician
In another project, Samaritan tracked pneumonia readmission rates as a quality-of-care measure. NF Blue made the task easy. "We found that readmissions were primarily associated with one physician and that a change in the formulary using a newly available drug was very effective at eliminating the high rate of readmissions," says Stambaugh. "If we had had to use chart reviews and manual methods for tracking, it just wouldn’t have happened for lack of time and resources. But with access to our data through a powerful application to find the outcome information, it leaves time for the chart reviews when they are occasionally needed."
Samaritan Healthcare sees this approach as necessary to survive and improve while some other smaller hospital systems may be folding for lack of information. Says Stambaugh, "We are excited about having the same capability as larger systems and are ready to focus it on the next area of need." That area: looking across major DRGs for utilization outliers and working with medical staff to update clinical outcomes indicators. "This system allows us to look into any question that comes up immediately."
The system still is evolving, with Net-Fast actively seeking input from users on how to improve the system. "PACE has excellent drill-down, but this is more flexible," Stambaugh says.
[Editor’s note: For more information on Net-Fast, call (978) 436-9100, or visit www.net-fast.com.]
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